This Week in PLOS Medicine: Estimating Lives Saved, Non-Midwives Oxytocin Injection, Pregnancy Weight & Child Obesity
This week PLOS Medicine publishes the following new articles:
The Global Fund estimates that 8.7 million lives were saved between 2002 and 2012 due to the provision of treatment for HIV (ART), directly-observed tuberculosis treatment (DOTS), and the distribution of insecticide-treated mosquito nets (ITNs) for malaria prevention. David McCoy and colleagues examine a number of sources of uncertainty and potential bias in The Global Fund’s methods used to calculate this estimate, and highlight that the degree of uncertainty over the figures is not reported. The authors discusses how the attribution of lives saved to specific programs or actors might negatively affect the overall governance and management of health systems, and how a narrow focus on just ART, DOTS, and ITNs could unintentionally lead to the neglect of other services and interventions. In an accompanying Perspective, Daniel Low-Beer and colleagues from The Global Fund argue that “lives saved” is an important measure for health programs and that The Global Fund’s estimate are based on real, verified data on a limited set of services, which have clear, documented mortality outcomes. The authors welcome the critique, as it discusses more fully the assumptions, explores the potential pitfalls in communication, and stresses the importance of investments in country financial and impact data.
Cynthia Stanton and colleagues report that community health officers (health workers who are not trained midwives) can safely give injections of oxytocin to prevent severe bleeding after delivery (postpartum hemorrhage) when attending home births in rural areas of Ghana. Oxytocin injections also halved the risk of postpartum hemorrhage in women who delivered at home in this cluster-randomized controlled trial, an important finding given that postpartum hemorrhage kills many women in sub-Saharan African countries. Maternal health care planners can consider extending the use of oxytocin into peripheral settings, including home births. In an accompanying Perspective, João Paulo Souza comments that the trial demonstrates the feasibility, safety, and impact of a community-based postpartum hemorrhage prevention strategy, and also contributes to health equity by empowering the community in under-resourced settings.
David Ludwig and colleagues report that women who gain excessive weight in pregnancy are more likely to have overweight and obese children, even after making allowances for differences in birthweight. In order to access whether childhood obesity was due just to the conditions during pregnancy (which influence birthweight) or whether other factors shared by mother and child (such as diet and genes) play a role, the study looked particularly at mothers with two or more children by combining two large public databases in US Arkansas. These results are important as measures to limit pregnancy weight gain may help prevent obesity in the subsequent generation. The authors conclude that additional research is needed to learn how best to advise pregnant women on managing their weight in pregnancy.